10:71-2.2 Responsibilities in the application process
(a) The Division of Medical Assistance and Health Services is the administrative unit of the
Department of Human Services responsible for coordinating the administration of Medicaid
Only with the Supplemental Security Income program. This Division provides for payment of
claims for, and evaluation of health services rendered under, Medicaid Only; maintains
administrative liaison with other departmental divisions; and provides professional, medical
and paramedical staff which is advisory to this Division in all matters of health care relevant
to the administration of Medicaid Only. This Division contracts with CBOSSs for
reimbursement of costs of administering the Medicaid Only program.
(b) The Division of Medical Assistance and Health Services and the Commissioner of the
Department of Human Services shall establish policy and procedures for the application
process and supervise the operation of and compliance with the policy and procedures so
established.
(c) The CBOSS exercises direct responsibility in the application process to:
1. Inform the applicants about the purpose and eligibility requirements for Medicaid Only,
inform them of their rights and responsibilities under its provisions and inform applicants of
their right to a fair hearing;
2. Receive applications;
3. Assist the applicants in exploring their eligibility for assistance;
4. Make known to the applicants the appropriate resources and services both within the agency and the community, and, if necessary, assist in their use;
5. Assure the prompt and accurate submission of eligibility data to the Medicaid status files
for eligible persons and prompt notification to ineligible persons of the reason(s) for their
ineligibility;
6. The CBOSSs shall also provide supportive social services which will enhance cure and
rehabilitation of beneficiaries of Medicaid Only.
(d) As a participant in the application process, an applicant shall:
1. Complete, with assistance from the CBOSS if needed, any forms required by the
CBOSS as a part of the application process;
2. Assist the CBOSS in securing evidence that corroborates his/her statements;
3. Report promptly any change affecting his or her circumstances